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Although melanotic pigmentation of the colon has been recognized for almost a century, there has been surprisingly little written on this subject from a clinical standpoint. In the course of routine sigmoidoscopic examinations, this striking type of discoloration is not infrequently seen. The color of the mucosa varies from buff to dark brown or black, the deeper shade being broken into small angular, polyhedral designs by fine netlike striae of lighter shade, either yellow or brown. These small fields vary in size between 2 and 10 mm. in diameter. Small pinhead yellow follicles are frequently seen, being more noticeable in the milder cases of melanosis. One of the earliest writers likened the appearance of the mucosa of the bowel to that of a toad's back.1 Others have compared the appearance to a snake, crocodile or tiger skin.2 To us the pigmentation suggests somewhat a cross section of nutmeg. REVIEW OF THE LITERATUREAccording to Stewart and Hickman,3 the first reference to a case of melanosis coli was that of Cruveilhier,4 who wrote in about 1830: "M. Andrai has found in an individual affected with chronic diarrhea, the inner surface of the large intestine as black as chínese ink, from the ileocecal valve right down to the rectum. The color resided in the internal membrane, which showed no other alterations beyond a remarkable development of its follicles." Virchow apparently first applied the name melanosis coli to this condition in 1858. His specimen, labeled in his own hand, is in the pathologic institute in Berlin. In 1898, SolgerB reported the autopsy examinations of seven cases which he termed "colitis pigmentosa," a term since discarded because inflammatory changes have not been demonstrated.

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